Acute Lymphoblastic Leukemia Presenting Research Articles

Acute Lymphoblastic Leukemia Presenting as Systemic Juvenile Idiopathic Arthritis: Experience from Bangladesh

Acute Lymphoblastic Leukemia Presenting as Systemic Juvenile Idiopathic Arthritis: Experience from Bangladesh

Philadelphia chromosome-positive acute lymphoblastic leukemia presenting with bilateral serous retinal detachment: A case report and review of the literature

We report a case who presented with bilateral serous retinal detachment (SRD) as the initial sign of Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL). A 49-year-old female presented with blurred vision. A colored fundus image of the patient revealed SRD around the posterior pole’s optic disc. Bone marrow aspiration showed infiltration with lymphoblasts. The patient was diagnosed with Ph+ ALL. SRD regressed in the color fundus image of the patient after induction chemotherapy and intrathecal methotrexate. The patient’s visual symptoms completely regressed. In conclusion, acute leukemia should be considered in the differential diagnosis of cases presenting with SRD.

A Rare Case of Adult Precursor B-Cell Lymphoblastic Lymphoma/Leukemia Presenting with Multiple Osteolytic Bone Lesions as Sole Manifestation

Abstract Primary precursor B-lymphoblastic lymphoma/leukemia (B-LBLL) of bone is uncommon neoplasm that accounts for less than 1% of primary bone tumors. It has been commonly reported in pediatric population but is rare in adults. We present a case of a 20-year-old man with multiple osteolytic lesions as sole presentation of acute lymphoblastic leukemia, whose diagnosis was established by bone biopsy. A peripheral blood smear and the bone marrow aspirate showed no blast cells. The patient received treatment according to BFM 99 protocol and achieved complete response confirmed by F-FDG-PET/CT.

Extramedullary relapsed acute lymphoblastic leukemia presenting as asymptomatic acute kidney injury after hematopoietic stem cell transplantation.

Acute kidney injury (AKI) is a common complication in children with hematological malignancies. Although AKI due to infiltration of tumor cells in children is rare, it negatively impacts treatment outcomes and increases the risk of mortality. We introduce a case of a child with acute lymphoblastic leukemia (ALL) who experienced kidney relapse resulting in asymptomatic AKI after remission from treatment, to remind clinicians not to overlook the primary disease in clinical judgment. In cases of unexplained AKI, kidney biopsy should be performed when feasible to get an accurate diagnosis and scientific treatment. In brief, children with leukemia who have achieved remission after treatment still need regular monitoring of urine routine and kidney function.

Cranial Nerve Palsies as Initial Presentation of Acute Lymphoblastic Leukemia – A Case Report

The clinical manifestations of acute leukemia are diverse and can range from asymptomatic to life-threatening Complications.1 Cranial nerve palsies as a presenting feature of this disease is relatively rare. It can be attributed to leukemic infiltration of cranial nerves, or the development of cranial nerve palsies secondary to intracranial complications such as subdural hematoma. Our patient presented with 4-month history of progressively worsening eye and visual disturbances. On examination, there was bilateral ptosis and proptosis. The right pupil was dilated and non-responsive to light with complete blindness. Left pupil had a sluggish response to light and had decreased visual acuity. There was 6th nerve palsy on left side and bilateral sensorineural hearing loss. Bone marrow biopsy showed Acute Lymphoblastic Leukemia. He was diagnosed with Acute Lymphoblastic Leukemia with brain (CNS) infiltration causing 2nd, 3rd, 6th and 8th cranial nerve palsies.

A Curious Case of Jaw Swelling due to Precursor B Cell Acute Lymphoblastic Leukemia

ABSTRACT Acute lymphoblastic leukemia (ALL) is a rare leukemia in adults but is the most common type in children. We present a case of a 40-year-old female presenting with jaw pain and swelling with fever which appeared to be an abscess. Further evaluation revealed the presence of blast cells in the peripheral blood smear. Flow cytometry was performed which further revealed pre-B cell ALL. It underwent spontaneous tumor lysis and despite all the resuscitative measures, she succumbed to sepsis and multiorgan dysfunction. The purpose of this report is to document an unusual manifestation of an adult B cell acute lymphoblastic leukemia (ALL) presenting as a jaw mass masquerading as an abscess undergoing spontaneous tumor lysis.

Precursor B-cell acute lymphoblastic leukemia presenting with isolated skin relapse: a pediatric case report

BackgroundIn childhood acute lymphocytic leukemia (ALL), relapse is most commonly seen in the bone marrow (10–20%), followed by the central nervous system (3–8%). Isolated skin relapse is very rare in ALL. We report an 8-year-old child presented with isolated skin relapse.Case presentationAn eight-year-old female patient presented with swelling on the scalp 3 months after the completion of the ALLIC-BFM 2009 chemotherapy protocol administered due to the diagnosis of precursor B-cell (pre-B) ALL. Physical examination revealed a hard, painless, hyperemic, nodule-shaped lesion measuring 2 × 1 cm on the right parietal bone. Atypical hematopoietic cells with the prominent nucleolus, narrow cytoplasm, and immunohistochemically stained with CD 10, 19, 22, 79-a, and TdT were observed in the histopathological examination of the skin lesion. There was no blast in the bone marrow aspiration smear and cerebrospinal fluid. The patient was diagnosed with aleukemic leukemia cutis (LC) and pre-B ALL, presenting as an isolated relapse.ConclusionAleukemic LC is a very rare finding after leukemia treatment. It may present with various cutaneous lesions, such as a papule, macule, plaque, nodule, palpable purpura, and ulcerative lesions. Leukemia cutis should be considered in the differential diagnosis of skin lesions developing during or after treatment in children with leukemia.

CD43-positive, EWSR1::FLI1 -rearranged Soft Tissue Sarcoma in a Pediatric Patient With History of B-Cell Acute Lymphoblastic Leukemia.

Ewing sarcoma is a small round blue cell tumor typically characterized by an EWSR1 rearrangement and expression of CD99 and NKX2.2, without expression of hematopoietic markers such as CD45. CD43 is an alternative hematopoietic immunohistochemical marker often utilized in the workup of these tumors and its expression typically argues against Ewing sarcoma. We report a 10-year-old with history of B-cell acute lymphoblastic leukemia presenting with an unusual malignant shoulder mass with variable CD43 positivity, but with an EWSR1::FLI1 fusion detected by RNA sequencing. Her challenging workup highlights the utility of next-generation DNA-based and RNA-based sequencing methods in cases with unclear or conflicting immunohistochemical results.

Pediatric B Cell Acute Lymphoblastic Leukemia presenting with Paraneoplastic Acute Disseminated Encephalomyelitis

Acute Disseminated Encephalomyelitis (ADEM) is a monophasic demyelinating disease most often triggered by infection or immunization, though associations with malignancy and stem cell transplant have been described. We described the case of a four-year-old boy with new-onset neurological symptoms associated with ADEM, acute leukemia, and equivocal evidence of Mycoplasma pneumoniae infection. He responded to a short course of antibiotics and chemotherapy for B cell acute lymphoblastic leukemia (B-ALL) that included a prolonged course of high dose steroids with immunosuppressive therapy. This case illustrated a possible association between paraneoplastic ADEM and leukemia in pediatric patients.

Prognosis of patients with acute lymphoblastic leukaemia relapsing after allogeneic stem cell transplantation.

To evaluate the outcomes of patients with ALL presenting relapsed after allo-SCT, we performed a retrospective study including 132 from 11 centres in Spain. Therapeutic strategies consisted of palliative treatment (n=22), chemotherapy (n=82), tyrosine kinase inhibitors (n=26), immunotherapy with inotuzumab and/or blinatumumab (n=19), donor lymphocyte infusions (n=29 pts), second allo-SCT (n=37) and CAR T therapy (n=14). The probability of overall survival (OS) at 1 and 5 years after relapse was 44% (95% confidence interval [CI]: 36%; 52%) and 19% (95% CI: 11%; 27%). In the 37 patients undergoing a second allo-SCT, the 5-year estimated OS probability was 40% [22%; 58%]. Younger age, recent allo-SCT, late relapse, 1st complete remission at 1st allo-SCT and chronic graft-versus-host disease confirmed their positive impact on survival in the multivariable analysis. Despite the poor prognosis of patients with ALL presenting relapse after a first allo-SCT, some can be satisfactorily rescued and a second allo-SCT still remains a valid option for selected patients. Moreover, emerging therapies really might improve ALL patients outcome when relapsing after an allo-SCT.

398 - A rare case of acute lymphocytic leukemia presenting with pediatric acute liver failure

398 - A rare case of acute lymphocytic leukemia presenting with pediatric acute liver failure

Is there a risk of early relapse in patients with acute lymphoblastic leukemia presenting with bone-associated symptoms?

Background/Aim: Acute lymphoblastic leukemia (ALL) is the most common malignancy in childhood. Patients usually present with fatigue, pallor, weight loss, and joint and/or bone findings. However, the effects of bone-associated symptoms on prognosis remains controversial. We aimed to demonstrate whether bone-associated symptoms affect prognosis in children with ALL.
 Methods: This retrospective cohort study included the data from 268 patients with ALL who were diagnosed and treated between January 2011 and December 2020. The patients were divided into two groups as those with and without bone-associated symptoms. We compared the groups in terms of age, gender, immunophenotyping, day 8 prednisolone response, and risk groups, in addition to minimal residual disease (MRD), relapse, and survival rates.
 Results: Eighty-five out of 268 (32%) children had bone-associated symptoms at the time of diagnosis, whereas others (n=183) had none of these symptoms. The relapse rate in children with bone-associated symptoms was found to be higher than the others (17.6% versus 12%), but the difference was not significant (P=0.24). However, children with bone findings developed earlier relapse when compared with the others (18.6 versus 28.6 months; P<0.001).
 Conclusion: Therefore, we suggest that bone-associated symptoms at the time of diagnosis could be considered a warning sign for earlier relapse, and these children should be carefully followed.

Acute lymphoblastic leukemia in an adult presenting with intractable pruritus.A Case report and review of literature.

This case report describes a case of an unusual initial presentation of acute lymphoblastic leukemia in a 22 year male. He presented with intractable pruritus, weight loss and loss of appetite for 1 month in the gastroenterology outpatient department. On investigating, his liver function test was deranged .Magnetic resonance cholangiopancreatography was suggestive of focal narrowing of proximal common bile duct with dilated intrahepatic biliary radicles. A complete serological evaluation for infective and autoimmune profile was negative. Patient underwent image guided liver biopsy. The core of biopsied liver showed infiltration by nests of round to oval tumor cells with markers consistent with B lymphoblastic leukemia /lymphoma not otherwise specified.

Acute lymphoblastic leukemia presenting as hepatitis in a young adult: An autopsy presentation

Acute lymphoblastic leukemia presenting as hepatitis in a young adult: An autopsy presentation

Mystifying joint pains: Acute lymphoblastic leukemia presenting as systemic onset juvenile idiopathic arthritis

Objectives: Acute Lymphoblastic Leukemia (ALL) in children presents with varied manifestations. At times, they may mimic symptoms and signs of Systemic onset Juvenile Idiopathic Arthritis (SoJIA). We analyzed children with ALL who were initially diagnosed as SoJIA thus leading to delay in diagnosis and treatment of ALL. Material and Methods: Retrospective study of records of 18 children diagnosed as ALL at our center between the period of January 2016 and December 2020, and who were initially diagnosed as SoJIA. Results: All 18 children presented with fever and joint pains involving large joints such as knee, ankle, wrist, and elbow. Seven (38.8%) cases had associated hepatosplenomegaly and three (16%) had lymphadenopathy at the time of presentation. Ten out of 18 children (55.6%) had normal peripheral complete blood counts. The duration from the time of onset of symptoms to diagnosis of ALL ranged from 15 days to 7 months in these cases. Four children had received steroids as treatment of SoJIA before they were diagnosed with ALL. Conclusion: Possibility of ALL must be ruled out in all cases suspected of having SoJIA, as leukemias may not always present with typical signs like hepatosplenomegaly, lymphadenopathy, or cytopenias. It will prevent delay in diagnosis and treatment of ALL. Administration of steroids to these patients for SoJIA, adversely affects post-ALL treatment outcomes.

Uveitis masquerade syndrome as an early manifestation of precursor B-cell acute lymphoblastic leukaemia: a case report

Background: To report a case of paediatric precursor B-cell acute lymphoblastic leukaemia (ALL) presenting as uveitis masquerade syndrome (UMS).
 Case presentation: A 3-year-old girl with neutropenic sepsis presented with poor fixation and right preferential gaze. Vision was light perception and counting fingers in OD and OS with bilateral panuveitis, and OS Roth spots, retinal haemorrhages, and exudates. Vitreous biopsy was negative for organisms, malignant cells, and blasts. Bone marrow aspiration and trephine biopsy (BMAT) was inconclusive for leukaemia and orbital MRI showed no infiltration. She improved with antimicrobials and steroids. During rehospitalization 6 months later for neutropenic sepsis, BMAT showed 80% blasts confirming B-cell precursor ALL, requiring chemotherapy. OD vision remained poor with band keratopathy, keratoconjunctivitis sicca, seclusio pupillae, cataract, and vitreous haemorrhage. OS vision improved partially with a macular scar.
 Conclusion: Paediatric precursor B-cell ALL may present as UMS. Prompt diagnosis and treatment may increase survival and visual potential.

Acute Unilateral Hypopyon Uveitis and Secondary Glaucoma in an Adult With Relapsing Acute Lymphoblastic Leukemia

Anterior segment infiltration in acute lymphoblastic leukemia (ALL) presenting as hypopyon uveitis in an adult is rare. We report this case as an uncommon presentation in a patient in remission after chemotherapy for ALL. In addition to the hypopyon, the patient presented with congested eye caused by secondary raised intraocular pressure. There is a need to maintain a high index of clinical suspicion in uveitis cases, as early diagnosis of ocular malignancy can save vision. Atypical unilateral hypopyon, even in adults, can be an indication of relapsing ALL.

PANCYTOPENIA AS INITIAL PRESENTATION OF ACUTE LYMPHOBLASTIC LEUKEMIA AND ITS ASSOCIATIONWITH BONE MARROWRESPONSE

Objective:The objective of this study is to determine the frequency of pancytopenia and bone marrow response to treatment of acute lymphoblastic leukemia. Materials And Methods:This is a cross sectional study carried out at Medical Oncology Department, Hayatabad Medical Complex, Peshawar. A total of 120 patients were included in the study. Venous blood sample was obtained from patients and sent to the laboratory of the hospital for assessment of red blood cells, white blood cells, and platelets. Reports were assessed and levels were noted. If levels were lower than normal, then patients were labeled as having pancytopenia was labeled.Patients were advised treatment i.e drug regimen including weekly intravenous vincristine, daunorubicin, weekly intrathecal methotrexate and daily dexamethosone for 4 weeks). After 4 weeks they underwent bone marrow aspiration. All samples were sent to the laboratory of the hospital for assessment of bone marrow response i.e M1 (less than 5% lymphoblasts), M2 (5% to 25% Lymphoblasts)& M3 (more than 25% Lymphoblasts). Results:Pancytopenia was recorded in 35 (29.16%) patients presenting with acute lymphoblastic leukemia. Out of these thirty-five patients, 21 (60%) were male and 14(40%) were female. Out the 21 males, 20 (95.24%)hadM1 responsewhile01(4.76%)patienthadM2response. Out of the14female patients,12(85.71 %)hadM1 response, 1(7.14 %) had M2 and 1(7.14%) had M3 response. Out of the 85 patients who did not have pancytopenia, 50 (58.8%) were male and 35 (41.2%) were female. Out of the 50 males withoutpancytopenia,36(72%) hadM1,10(20%)hadM2and4(8%) hadM3response.Among the 35 female patients, 31(88.57%) had M1, 2(5.71%) had M2 and 2(5.71%) had M3 response. Conclusion:The study concluded that although pancytopenia is a fairly common presentation of acute lymphoblastic leukemia but there is no significant difference in the outcome of patients receiving treatment for acute lymphoblastic leukemia in association with presence or absence of pancytopenia as initial presentation or with respect to duration of the disease.

PANCYTOPENIA AS INITIAL PRESENTATION OF ACUTE LYMPHOBLASTIC LEUKEMIA AND ITS ASSOCIATIONWITH BONE MARROWRESPONSE

PANCYTOPENIA AS INITIAL PRESENTATION OF ACUTE LYMPHOBLASTIC LEUKEMIA AND ITS ASSOCIATIONWITH BONE MARROWRESPONSE

Bilateral Metastatic Acute Lymphoblastic Leukaemia Presenting as Hypopyon: A Case Report

Bilateral Metastatic Acute Lymphoblastic Leukaemia Presenting as Hypopyon: A Case Report